Nerve Transfer Restores Hand Function in Spinal Cord Injury

MedicalResearch.com Interview with:

Natasha van Zyl, MBChB (Cape Town), FRACS FRACS Plastic and Reconstructive Surgeon Melbourne, Australia 

Dr Natasha van Zy

Dr. Natasha van Zyl, MBChB (Cape Town), FRACS
FRACS Plastic and Reconstructive Surgeon
Melbourne, Australia 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The estimated global incidence of spinal cord injury (SCI) from all causes is 40 to 80 new cases per million population per year which means that every year between 250 000 to 500 000 people worldwide suffer SCI (1)(chap 2 p 17). In Australia the age standardised, annual incident rate of persisting traumatic SCI for Australian residents aged 15 years and above is 11.8 cases per million.(2) Just over 50% of all spinal cord injuries  in Australia occur at the cervical level resulting in tetraplegia. (2)

Cervical spinal cord injury is a devastating, life-changing injury impacting almost every aspect of a person’s work, family and social life. Although compared to many other health conditions it has a relatively low incidence, it is certainly a high cost health condition, with the lifetime cost per tetraplegia incident case estimated to be AU$9.5 million.(3) For those living with tetraplegia improvement in hand function is their highest ranked goal.(4) As such, reconstruction of upper extremity function in cervical spinal cord injury is a crucial component of the surgical rehabilitation of people with mid/low cervical spinal cord injury as it has the capacity to restore critical functions such as elbow extension, wrist extension, grasp, key pinch and release. Traditionally these functions have been reconstructed using tendon transfers, which move a functioning muscle to a new insertion site to recreate the function of a paralysed muscle.(5)

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BrainGate Technology Allows Tetraplegics To Rapidly Control Brain-Computer Interface

MedicalResearch.com Interview with:

Matthew McKee/BrainGate Collaboration

New technique enables rapid calibration of the BrainGate brain-computer interface.

David Brandman, MD, PhD
Postdoctoral research associate (neuroengineering), Brown University
Senior neurosurgical resident
Dalhousie University
BrainGate Website

MedicalResearch.com: What is the background for this study?

Response: People with cervical spinal cord injuries, ALS, or brainstem stroke, may lose some or all of their ability to use their arms or hands. In some cases, they may even lose the ability to speak. One approach to restoring neurologic function is by using a brain computer interface (BCI). BCIs record information from the brain, and then translate the recorded brain signals into commands used to control external devices. Our research group and others have shown that intracortical BCIs can provide people with tetraplegia the ability to communicate via a typing interface, to control a robotic limb for self-feeding, and to move their own muscles using functional electrical stimulation. Use of a BCI generally requires the oversight of a trained technician, both for system setup and calibration, before users can begin using the system independently.

An open question with intracortical BCIs is how long it takes people to get up and running before they can communicate independently with 2 dimensional cursor control. The goal of this study was to systematically examine this question in three people with paralysis. As part of the ongoing BrainGate2 clinical trial, each study participant (T5, T8, and T10) had tiny (4×4 mm) arrays of electrodes implanted into a part of their brain that coordinates arm control. Each participant used motor imagery – that is, attempted or imagined moving their body – to control a computer cursor in real time.

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Lampreys Can Regenerate Severed Spinal Cord – Maybe Humans Can Too

MedicalResearch.com Interview with:
Ona Bloom PhD
“Duluth Boat Show - Sea Lamprey Booth” by USFWSmidwest is licensed under CC BY 2.0Associate Professor, Center for Autoimmune, Musculoskeletal and Hematopoietic Diseases,
The Feinstein Institute for Medical Research
Associate Professor, Department of Molecular Medicine,
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Scientists have known for years that an ancient species of fish called the lamprey has a remarkable ability to rebuild their spinal cord after it’s been severed. After the lamprey spinal cord is cut, they recover from paralysis to fully swimming again in about twelve weeks, without taking any medicines or other treatments. We are studying the lamprey because we want to know the recipe of molecular ingredients that supports successful recovery after spinal cord injury.

The genome of this animal was reported about 5 years ago, in a publication led by my colleagues Dr. Jeramiah Smith at the University of Kentucky and Dr. Weiming Li at Michigan State University.  It turns out that many aspects of the lamprey genome are similar to ours, particularly in the central nervous system. Therefore, we think it is a reasonable expectation that what we learn from lamprey could give us some relevant clues about what might be different about the responses in mammals and other animals that are not good at regenerating their spinal cord.

In this study, we found that the expression of many genes in the spinal cord and brain of lampreys change during their recovery from spinal cord injury. Some of the genes that get activated are similar to what happens when our peripheral nervous system is injured, which is better at regenerating than the central nervous system. We also identified that a pathway called the Wnt pathway plays an important role in the regeneration and recovery process. This is a large, complex network of genes that are important in many biological processes, from embryological development in fruit flies to cancer in humans. Continue reading

Robotics Can Be Used To Train Brain To Recover Hand Use After Stroke

MedicalResearch.com Interview with:

The Brain-Machine Interface (BMI) setup applied in this study. Participants imagine opening their hand without actually making any movement while their hand is placed in a device that passively opens and closes their fingers as it receives the necessary input from their brain activity.

The Brain-Machine Interface (BMI) setup applied in this study. Participants imagine opening their hand without actually making any movement while their hand is placed in a device that passively opens and closes their fingers as it receives the necessary input from their brain activity.

Professor Alireza Gharabaghi
Univ.-Prof. Dr. med. Alireza Gharabaghi
Ärztlicher Leiter
Sektion Funktionelle und Restaurative Neurochirurgie
Neurochirurgische Universitätsklinik
Eberhard Karls Universität Tübingen 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: According to the World Health Organization, 15 million people suffer stroke worldwide each year. Of these, 5 million die and another 5 million are permanently disabled. Stroke is the leading cause of serious, long-term disability. About half of all stroke survivors will never be able to use their affected hand for activities of daily living again.

The current study investigates a novel technology which may lead to new therapeutic options for these patients. 

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Study Compares Three Types of Botulinum Injections For Involuntary Facial Movements

MedicalResearch.com Interview with:

P. Daniel Ward, MD, MS, FACS Facial Plastic Surgeon WardMD Form Medical SpaAdjunct Associate Professor, University of Utah School of Medicine Salt Lake City, Utah 84121

Dr. Ward

P. Daniel Ward, MD, MS, FACS
Facial Plastic Surgeon
WardMD Form Medical SpaAdjunct Associate Professor, University of Utah School of Medicine
Salt Lake City, Utah 84121

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As a facial plastic surgeon with an interest in finding treatments for patients with facial paralysis, we are always looking for ways to improve the care that our patients receive. One of those treatments is to treat the effects of abnormal and asymmetric facial motion with botulinum, which decreases the deformity that results from facial nerve disorders by decreasing muscular hyperactivity.

This study was based on the fact that there are three commercially available types of botulinum available for treatment of the face. There have been studies that have compared the different types of botulinum for cosmetic purposes, but there have not been any studies that specifically looked to see if there were any differences between the different types of botulinum when used for treatment of facial nerve disorders.

The main finding of the study is that the three different types of botulinum are essentially equivalent with the exception being that one type of botulinum, incobotulinum toxin, was slightly less effective than the other two types of botulinum at the 4-week follow up point. Of note, all three types were equivalent at all other time points.

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